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[Neuromeningeal tuberculosis in northeastern suburbs of Paris. Nineteen cases]
Mylène Grimaud-Ayina1, Olivier Fain, Olivier Lortholary
1Service de Médecine Interne, Laboratoire de Microbiologie, Hôpital Jean-Verdier, 93143 Bondy Cedex, France.
Subject:
Analyze characteristics of neuromeningeal tuberculosis in the northeastern suburbs of Paris.
Material And Method:
Retrospective study of 19 observations between 1988 and 1999.
Results:
Thirteen cases of meningitis, 3 cases of meningitis associated with a tuberculoma and 3 cases with isolated tuberculoma were described. Young subjects (average age 46.4), foreign born (73.7%) were preferentially affected. Three patients were infected by the human immunodeficiency virus. Weight-loss and weakness (84%), fever (79%), headache (63%) dominate the clinical manifestations. The diagnosis delay was 56.6 days, and the therapeutic time, 8.6 days. The search for acid fast bacilli was positive only in one case on direct examination of the cerebrospinal fluid, whereas the culture was positive in 68.7% of the cases. Cerebral imagery was abnormal in13 patients. Average duration of antituberculous treatment was 13,4 months (range: 9-24). Corticosteroids were associated in 12 patients. Thirteen patients were cured, 3 died and 3 were lost to follow up.
Conclusion:
The characteristics of neuromeningeal tuberculosis are not modified, but the diagnosis delay of the neuromeningeal tuberculosis, which conditions the prognosis, remains significant. The optimal duration of the antituberculous treatment and the conditions of the steroid therapy have to be specified.
Insights
Neuromeningeal tuberculosis predominantly affects young, foreign-born individuals and presents with non-specific symptoms. Delays in diagnosing this serious form of tuberculosis significantly impact patient outcomes.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Context:
- Neuromeningeal tuberculosis is a severe form of Mycobacterium tuberculosis infection affecting the brain and meninges.
- This study examines cases in the northeastern suburbs of Paris, a region with a diverse population.
Purpose:
- To analyze the epidemiological and clinical characteristics of neuromeningeal tuberculosis.
- To identify factors influencing diagnosis and treatment outcomes.
Summary:
- A retrospective study of 19 patients revealed that neuromeningeal tuberculosis primarily affects young, foreign-born individuals.
- Clinical manifestations include weight loss, weakness, fever, and headache, with a significant diagnostic delay.
- Cerebrospinal fluid cultures were more sensitive than direct examination for identifying Mycobacterium tuberculosis.
Impact:
- Highlights the persistent challenge of delayed diagnosis in neuromeningeal tuberculosis, emphasizing its impact on prognosis.
- Suggests the need for further research into optimal treatment durations and the role of corticosteroid therapy.